Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 08.00.08j


Attachment:A

Policy #:08.00.08j

Description:ICD-10 Codes

Title:Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (Independence Administrators)


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



C82.00 Follicular lymphoma grade I, unspecified site

C82.01 Follicular lymphoma grade I, lymph nodes of head, face, and neck

C82.02 Follicular lymphoma grade I, intrathoracic lymph nodes

C82.03 Follicular lymphoma grade I, intra-abdominal lymph nodes

C82.04 Follicular lymphoma grade I, lymph nodes of axilla and upper limb

C82.05 Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb

C82.06 Follicular lymphoma grade I, intrapelvic lymph nodes

C82.07 Follicular lymphoma grade I, spleen

C82.08 Follicular lymphoma grade I, lymph nodes of multiple sites

C82.09 Follicular lymphoma grade I, extranodal and solid organ sites

C82.10 Follicular lymphoma grade II, unspecified site

C82.11 Follicular lymphoma grade II, lymph nodes of head, face, and neck

C82.12 Follicular lymphoma grade II, intrathoracic lymph nodes

C82.13 Follicular lymphoma grade II, intra-abdominal lymph nodes

C82.14 Follicular lymphoma grade II, lymph nodes of axilla and upper limb

C82.15 Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb

C82.16 Follicular lymphoma grade II, intrapelvic lymph nodes

C82.17 Follicular lymphoma grade II, spleen

C82.18 Follicular lymphoma grade II, lymph nodes of multiple sites

C82.19 Follicular lymphoma grade II, extranodal and solid organ sites

C82.20 Follicular lymphoma grade III, unspecified, unspecified site

C82.21 Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck

C82.22 Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes

C82.23 Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes

C82.24 Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb

C82.25 Follicular lymphoma grade III, unspecified, lymph nodes of inguinal region and lower limb

C82.26 Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes

C82.27 Follicular lymphoma grade III, unspecified, spleen

C82.28 Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites

C82.29 Follicular lymphoma grade III, unspecified, extranodal and solid organ sites

C82.30 Follicular lymphoma grade IIIa, unspecified site

C82.31 Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck

C82.32 Follicular lymphoma grade IIIa, intrathoracic lymph nodes

C82.33 Follicular lymphoma grade IIIa, intra-abdominal lymph nodes

C82.34 Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb

C82.35 Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb

C82.36 Follicular lymphoma grade IIIa, intrapelvic lymph nodes

C82.37 Follicular lymphoma grade IIIa, spleen

C82.38 Follicular lymphoma grade IIIa, lymph nodes of multiple sites

C82.39 Follicular lymphoma grade IIIa, extranodal and solid organ sites

C82.40 Follicular lymphoma grade IIIb, unspecified site

C82.41 Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck

C82.42 Follicular lymphoma grade IIIb, intrathoracic lymph nodes

C82.43 Follicular lymphoma grade IIIb, intra-abdominal lymph nodes

C82.44 Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb

C82.45 Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb

C82.46 Follicular lymphoma grade IIIb, intrapelvic lymph nodes

C82.47 Follicular lymphoma grade IIIb, spleen

C82.48 Follicular lymphoma grade IIIb, lymph nodes of multiple sites

C82.49 Follicular lymphoma grade IIIb, extranodal and solid organ sites

C82.50 Diffuse follicle center lymphoma, unspecified site

C82.51 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck

C82.52 Diffuse follicle center lymphoma, intrathoracic lymph nodes

C82.53 Diffuse follicle center lymphoma, intra-abdominal lymph nodes

C82.54 Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb

C82.55 Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb

C82.56 Diffuse follicle center lymphoma, intrapelvic lymph nodes

C82.57 Diffuse follicle center lymphoma, spleen

C82.58 Diffuse follicle center lymphoma, lymph nodes of multiple sites

C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites

C82.60 Cutaneous follicle center lymphoma, unspecified site

C82.61 Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck

C82.62 Cutaneous follicle center lymphoma, intrathoracic lymph nodes

C82.63 Cutaneous follicle center lymphoma, intra-abdominal lymph nodes

C82.64 Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb

C82.65 Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb

C82.66 Cutaneous follicle center lymphoma, intrapelvic lymph nodes

C82.67 Cutaneous follicle center lymphoma, spleen

C82.68 Cutaneous follicle center lymphoma, lymph nodes of multiple sites

C82.69 Cutaneous follicle center lymphoma, extranodal and solid organ sites

C82.80 Other types of follicular lymphoma, unspecified site

C82.81 Other types of follicular lymphoma, lymph nodes of head, face, and neck

C82.82 Other types of follicular lymphoma, intrathoracic lymph nodes

C82.83 Other types of follicular lymphoma, intra-abdominal lymph nodes

C82.84 Other types of follicular lymphoma, lymph nodes of axilla and upper limb

C82.85 Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb

C82.86 Other types of follicular lymphoma, intrapelvic lymph nodes

C82.87 Other types of follicular lymphoma, spleen

C82.88 Other types of follicular lymphoma, lymph nodes of multiple sites

C82.89 Other types of follicular lymphoma, extranodal and solid organ sites

C82.90 Follicular lymphoma, unspecified, unspecified site

C82.91 Follicular lymphoma, unspecified, lymph nodes of head, face, and neck

C82.92 Follicular lymphoma, unspecified, intrathoracic lymph nodes

C82.93 Follicular lymphoma, unspecified, intra-abdominal lymph nodes

C82.94 Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb

C82.95 Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb

C82.96 Follicular lymphoma, unspecified, intrapelvic lymph nodes

C82.97 Follicular lymphoma, unspecified, spleen

C82.98 Follicular lymphoma, unspecified, lymph nodes of multiple sites

C82.99 Follicular lymphoma, unspecified, extranodal and solid organ sites

C83.30 Diffuse large B-cell lymphoma, unspecified site

C83.31 Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck

C83.32 Diffuse large B-cell lymphoma, intrathoracic lymph nodes

C83.33 Diffuse large B-cell lymphoma, intra-abdominal lymph nodes

C83.34 Diffuse large B-cell lymphoma, lymph nodes of axilla and upper limb

C83.35 Diffuse large B-cell lymphoma, lymph nodes of inguinal region and lower limb

C83.36 Diffuse large B-cell lymphoma, intrapelvic lymph nodes

C83.37 Diffuse large B-cell lymphoma, spleen

C83.38 Diffuse large B-cell lymphoma, lymph nodes of multiple sites

C83.39 Diffuse large B-cell lymphoma, extranodal and solid organ sites

C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]

Z85.72 Personal history of non-Hodgkin lymphomas

Version Effective Date: 03/04/2019
Version Issued Date: 03/04/2019
Version Reissued Date: N/A

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